Successful Percutaneous Closure of an Aortic Graft Pseudo- Aneurysm
Endovascular stent-grafts, prosthetic grafts placed over expandable stents, are an alternative therapy for the treatment of arterial aneurysms, pseudo-aneurysms, dissections, penetrating ulcers and coarctations. However, there are limitations to their applicability. Described here is a patient with Takayasu's arteritis, an inflammatory disease of medium- to large-sized vessels, who developed a discrete pseudo-aneurysm in an open surgically placed aortic graft. She had previously undergone two separate surgeries for the treatment of thoracic aortic aneurysms. Due to the potential for reduced morbidity and mortality, endovascular stenting was a rational approach for a focal graft defect. Endovascular stent-graft repair could not be performed because the ratio of the required vascular sheath to peripheral vessel size was prohibitive in this patient. Instead, endovascular therapy using an Amplatzer patent foramen ovale occluder device was delivered within the pseudo-aneurysm to seal the connection to the aortic lumen. With radiographic and clinical follow up at 34 months, the patient has done well and not required any additional procedures.